Facing Execution Drug Shortage, States Struggle To Get Cocktail RightA botched execution in Oklahoma is only the latest issue since states started having trouble obtaining the drugs used to execute inmates. They've been trying new combinations and new drugs, which often had never been used before for that purpose.

A botched execution in Oklahoma is only the latest issue since states started having trouble obtaining the drugs used to execute inmates. They've been trying new combinations and new drugs, which often had never been used before for that purpose.

ROBERT SIEGEL, HOST:

And as Martin mentioned, states have been having trouble obtaining the drugs used in lethal injections. Joining us now to explain what's been happening is NPR's health correspondent Rob Stein. And, Rob, what are these drugs exactly and how do they work?

ROB STEIN, BYLINE: Yeah, Robert. You know, for years, there was a standard way to execute someone in the United States by injecting them with drugs. And this was a three-drug cocktail that the Supreme Court had ruled was constitutional. Now, here's how it worked. The first drug was called sodium thiopental, and that basically knocked the person out, it made them unconscious. The second drug is called pancuronium bromide, and that basically would paralyze the inmate so they couldn't move. And then finally they would administer a drug called potassium chloride. That's a toxin that would stop their heart. And that's the drug that would kill them. Now, this cocktail was actually, coincidentally, created by a medical examiner in Oklahoma - same state - in 1977. I've spoken to Dr. Jay Chapman several times over the years as controversy has arisen over this cocktail.

SIEGEL: Yeah, the controversy began after states started having difficulties getting those drugs in recent years. Remind us again of what happened.

STEIN: This is actually part of a broader problem that we've been having in this country where there's been shortages of lots of different drugs and there's been a variety of factors that have contributed to that. One of them is the consolidation in the pharmaceutical industry. So, there are fewer and fewer companies making a lot of these drugs and sometimes only one or two. And when it hit the lethal injection issue because when a company that is based in Italy, actually, decided that it no longer wanted to ship the first drug, sodium thiopenthal, to the United States because of objections to the death penalty in the United States. And that started companies, states scrambling to find other sources of drugs. Then a Danish company stopped shipping another drug that had been used to replace that drug. And then the EU banned distributing these drugs to the United States. States started looking to other countries, like Britain and Germany, and that ran into problems with other government agencies, like the Food and Drug Administration and the Drug Enforcement Agency. And then finally, they ended up turning to these compounding pharmacies, which are small pharmacies that mix small batches of drugs.

SIEGEL: Rob, which are still making the three drugs or a mishmash of various different kinds of substances?

STEIN: Well, now that's the situation now. It's really a mishmash. If you go around the country, from state to state, there have been different states using different formulas. Some states are only using one drug, some states are using two drugs, some are using three. And the mix of those drugs varies from state to state. And some of these drugs had never been used before. And that's why we're starting to see all these problems emerge.

SIEGEL: What about the role of doctors in all this? In Oklahoma, there's some question about whether the drug was administered properly, and it was a doctor taking part in this. Who actually carries out executions?

STEIN: Yeah, that's a really interesting issue and it's extremely controversial. You know, all the major medical organizations, like the American Medical Association, have very clear guidelines about this. And they say that doctors should not participate in executions, that it's unethical. Nevertheless, it's clear that in some cases doctors are involved but in most cases we don't know who they are and we don't really know what role they're playing. Sometimes they might be there just to sign a death certificate after pronouncing the inmate dead. In other cases, they may actually be administering the drugs. We really don't know. But in some cases, there may not be a doctor to actually administering a drug. It may be a prison work or a prison official who doesn't have a lot of training, and that could cause its own problems.

SIEGEL: States can use different protocols because there's no national standard here, is that right?

STEIN: That's right. It's left up to each individual state and they decide for themselves how to do it. And some state - and that's another issue of transparency. In some cases, state law makes it clear that they have to make all the information public and they have to go through a public comment period if they're going to change their protocol. In other states, it's just left up to the corrections department to do what they want, and they don't necessarily have to provide all the details about what drugs they're using, what doses, where they're getting their drugs.

SIEGEL: And I gather there's one odd pointer: a lot of the people being executed may be drug addicts or former drug addicts, that may complicate finding a vein.

STEIN: Yes, exactly. So, if you had - one of the issues with the execution in Oklahoma was, was the IV put in the right way? Did the vein collapse for some reason? The inmate's lawyer says no, that he was not a drug addict and that shouldn't have been an issue.

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